[quote=flyer]BG, you make some very good points, and I think the reason many people don’t understand your level of concern regarding medical coverage, is because they are not yet 50+, so they are not yet in the health coverage danger zone.
Very few younger people will have lifetime health insurance at any level provided by their employers as we have, so, if they should find themselves without coverage during that critical time of their lives, and the government doesn’t find a way to continue to subsidize them indefinitely without going bankrupt (good luck with that) they will eventually understand exactly what you have been talking about. Sometimes experience IS the best teacher.[/quote]Thanks, flyer. I tried to explain the obamacare debacle ad nauseam on this forum, replete with dozens of links explaining in intimate detail all the dozens of problems with dealing with the exchange. (Even enrolled health exchange agents, who have their own screens and special passwords on Covered CA have massive, intractable problems with their clients’ accounts.) This is all due to Covered CA’s (CC) and Medi-Cal’s utter incompetence due to too many fingers in the pot, too many working parts which are NOT working in tandem with one other, poor interpretation of the law as well as having the hopelessly understaffed IRS involved in this mess. The ~30 or so links I posted here are just the tip the iceberg.
Be prepared to spend 4-36 hours PER MONTH “maintaining” your OWN CC account if you are over 55 and your monthly income is within ~250% of “poverty level.” CC (and Medi-Cal) will do whatever it takes to get your income down below the Medi-Cal threshold and will do it behind your back without notice …. all the while you believe you have coverage because you paid your premium on time. Once you’re thrown into “the system” (involuntarily) you’re stuck in there for a minimum of 9 months and often the entire year (and longer, if you don’t file a timely appeal and pursue it thru to administrative hearing). One stuck in Medi-Cal can’t buy off-exchange individual coverage after the “enrollment period” is up because Medi-Cal is considered to be “ACA-compliant.” In any case, the only choices off-exchange in SD County are a handful (2-3) HMOs and 1-2 Bronze-level PPOs. Everything else is gone.
I’m probably one of the most anal-retentive ex-bureaucrats you will ever meet and I have never seen anything like this colossal mess that is the ACA …… ever. Never in my lifetime did I think I was going to have to keep copious records in paper (mostly everything in every file off my CC account and visit it very regularly (at least once per wk) to see, what, if anything was done behind my back. Nor did I think I would have to wait up to 3 hrs to speak with a CC rep on the phone and log every single name and agent number and everything that transpired during the call (I’ve taken to recording them). I feel all this must be done because CC tries to cover their errors after the fact (when they’ve been pointed out by a customer or agent to a supervisor) by deleting the erroneous entry in the customer’s case, or worse, locking the customers CC case so they (and their agent) no longer have access to it.
CC needs to be dismantled forthwith and all those clowns running it and “working” in it let go (maybe 5-10% of their reps attempt to be honest to customers but don’t have the skills or computer access to fix their problems).
Nor did I think I was going to have to deal with County Social Services (Medi-Cal) and discuss all my private business with them. WTF?? Are you joking me? Ha, ha, I used to be one of YOU!
If a CC customer over 55 pays less attention to their CC account than I do (most everyone), then they’re setting themselves up for forced Medi-Cal placement for the purposes of “Estate Recovery.” I feel sorry for those CC enrollees for which English is not their first language. I’ve helped several people with their CC problems and was successful and am probably now nearly qualified to be one of their enrolled agent/navigators but I don’t want the job. It’s too time-consuming and NOT financially rewarding for the time you put into it. I applaud those agents with the patience of Job who assist in signing up many families on Medi-Cal and take care of all of their inevitable enrollment problems, which take many, many hours to fix. I think it is really unfortunate that so many middle-income people are unwittingly thrown into that system (over 12M now in CA) when it didn’t have enough providers to serve the <3M who were in it prior to obamacare.
In addition, CC issued tens of thousands of Form 1095's this year to exchange customers which were in error, refusing to correct them and causing these poor slobs to have to file extensions on their tax returns. Lots of these working stiffs were expecting large refunds (even the EIC) and cannot get those refunds until they can file their returns. These erroneous 1095 forms were sent to customers who changed plans from Jan-March (before open enrollment ended) or who were required to "prove their incomes to CC during the year, causing CC''s "system" to boot them out and set them up as a "new" client with a "new" plan with a slightly different subsidy and even a different premium (if they had a birthday since they signed up for or renewed their plan) under the same case number even if they kept the same plan as they always had! The “system” then mailed them a new “Welcome to CC” letter and started their account all over again. This happened to me when I was required to prove my income again in March 2016. I rec’d a new welcome letter from CC this past April with my new subsidy ($26 difference) and I have been with them since 1/1/14! So this group who rec’d the erroneous 1095A forms from CC are enrollees whose APTC and possibly monthly premium changed one or more times during the year (it wasn’t the same amount every month). I fully expect to get an erroneous Form 1095A from CC for tax year 2016. When it doesn’t match the subsidies I (and my carrier) state that I was/they were paid on my 2016 Form 8962, I’ll get a “12C letter” from the IRS about 2 months after I file my taxes. It’s okay. I now know the drill.
This doesn’t even take into account the intransigent problems with the exchange carriers. These problems mostly have to do with billing (carriers taking too much from customer’s credit cards and bank accounts), wrong start/stop dates of enrollment, failure to issue a timely member ID card (or one at all) and failure to delete providers from their website when they drop out of serving exchange customers.
We exchange planholders are forced to put up with all this crap (daily/weekly/monthly) just for the “opportunity” to get an (often small) subsidy to help us pay our now exorbitant premiums under “obamacare.”
I could go on and on …. and on. Suffice to say that CC and their uber-tight bedfellow, Medi-Cal, is still a colossal, effed-up mess for everyone who finds themselves involved with it. In my humble opinion, these problems are not fixable. My being “bumped” from my plan last November while I was on the road, traveling and having to get it reinstated (again) seriously caused me to develop high blood pressure (136/94) just after Thanksgiving last year (I never had HBP in my life). Thankfully, I was able to get it lowered without medication before the holidays.
Honestly, I don’t think too many Piggs have actually read any of my eye-opening posts re: the mechanics of the ACA. I mean …. you’re right, flyer. Why should they care? The truth is, they don’t want to know. The ACA really doesn’t affect worker bees who have employer coverage too much. And Estate Recovery doesn’t apply to people under the age of 55 who sign up for Medi-Cal.
Until one actually walks in another’s shoes, they can’t possibly know or understand why they feel the way they do.
